SPECIMEN MANAGEMENT IN DIAGNOSTIC MICROBIOLOGY

BASICS DR.T.V.RAO MD

Dr.T.V.Rao MD 1

THE IMPACT OF PROPER SPECIMEN MANAGEMENT

• THE IMPACT OF PROPER SPECIMEN

MANAGEMENT ON PATIENT CARE IS

ENORMOUS. IT IS THE KEY TO

ACCURATE LABORATORY DIAGNOSIS

AND CONFIRMATION, IT DIRECTLY

AFFECTS PATIENT CARE AND PATIENT

OUTCOMES, IT INFLUENCES

THERAPEUTIC DECISIONS, IT IMPACTS

HOSPITAL INFECTION CONTROL, IT

IMPACTS PATIENT LENGTH OF STAY,

HOSPITAL COSTS, AND LABORATORY

COSTS, AND INFLUENCES

LABORATORY EFFICIENCY.

Dr.T.V.Rao MD 2

CLINICAL STAFF SHOULD CONSULT THE LABORATORY AT MANY STAGES

• CLINICIANS SHOULD

CONSULT THE

LABORATORY TO

ENSURE THAT

SELECTION,

COLLECTION,

TRANSPORT, AND

STORAGE OF PATIENT

Dr.T.V.Rao MD 3

FIRST CRITERIA FOR COLLECTION OF INFECTED MATERIAL OR BLOOD

SPECIMENS • A SPECIMEN SHOULD BE

COLLECTED PRIOR TO

ADMINISTRATION OF

ANTIBIOTICS. ONCE

ANTIBIOTICS HAVE BEEN

STARTED, THE FLORA

CHANGES, LEADING TO

POTENTIALLY MISLEADING

CULTURE RESULTS.

Dr.T.V.Rao MD 4

LABEL ALL THE SPECIMEN WITH OPTIMAL INFORMATION

• SPECIMENS MUST

BE LABELLED

ACCURATELY AND

COMPLETELY SO

THAT

INTERPRETATION OF

RESULTS WILL BE

Dr.T.V.Rao MD 5

MODERN LABORATORIES ARE ADVANCING WITH

BARCODING

Dr.T.V.Rao MD 6

COMPLETE SPECIMEN INFORMATION GUIDES THE LABORATORY

• LABELS SUCH AS “EYE”

AND “WOUND” ARE NOT

HELPFUL TO THE

INTERPRETATION OF

RESULTS WITHOUT

MORE SPECIFIC SITE

AND CLINICAL

INFORMATION (EG, DOG

BITE WOUND RIGHT

Dr.T.V.Rao MD 7

WHO IS RESPONSIBLE FOR SPECIMEN COLLECTION

• MICROBIOLOGY SPECIMEN

SELECTION AND COLLECTION

ARE THE RESPONSIBILITY OF

THE MEDICAL STAFF, NOT

USUALLY THE LABORATORY,

ALTHOUGH THE CERTIFIED

SPECIALIST OR QUALFIED

MICROBIOLOGIST MAY BE

CALLED UPON FOR

CONSULTATION OR

ASSISTANCE.

Dr.T.V.Rao MD 8

Dr.T.V.Rao MD 9

TENETS OF SPECIMEN MANAGEMENT

Dr.T.V.Rao MD 10

REJECTION OF SPECIMENS DONE WITH WISDOM AND EXPERIENCE

• SPECIMENS OF POOR

QUALITY MUST BE

REJECTED.

MICROBIOLOGISTS ACT

CORRECTLY AND

RESPONSIBLY WHEN THEY

CALL PHYSICIANS TO

CLARIFY AND RESOLVE

PROBLEMS WITH

Dr.T.V.Rao MD 11

THE TRUE PROBLEM WITH MICROBIOLOGY

Dr.T.V.Rao MD 12

EVERYTHING THAT GROWN CULTURE PLATE IS NOT PATHOGENIC

• PHYSICIANS SHOULD NOT

DEMAND THAT THE

LABORATORY REPORT

“EVERYTHING THAT GROWS,”

THUS PROVIDING IRRELEVANT

INFORMATION THAT COULD

RESULT IN INACCURATE

DIAGNOSIS AND

INAPPROPRIATE THERAPY.

• IT IS DANGEROUS TO

Dr.T.V.Rao MD 13

DO REMEMBER THE NORMAL FROM MANY SITES TO BE IGNORED FOR

PROCESSING

• “MANY BODY SITES HAVE

NORMAL MICROBIOTA THAT

CAN EASILY CONTAMINATE

THE SPECIMEN. THEREFORE,

SPECIMENS FROM SITES SUCH

AS LOWER RESPIRATORY

TRACT (SPUTUM), NASAL

SINUSES, SUPERFICIAL

WOUNDS, FISTULAE, AND

OTHERS REQUIRE CARE IN

COLLECTION.

Dr.T.V.Rao MD 14

SWABS FROM SURGICAL DEPARTMENTS ARE NOT IDEAL

SPECIMENS

• THE LABORATORY

REQUIRES A SPECIMEN,

NOT A SWAB OF A

SPECIMEN. ACTUAL

TISSUE, ASPIRATES, AND

FLUIDS ARE ALWAYS

SPECIMENS OF CHOICE,

ESPECIALLY FROM

SURGERY

Dr.T.V.Rao MD 15

WHY SWABS ARE NOT IDEAL FOR PROCESSING

• A SWAB IS NOT THE SPECIMEN OF

CHOICE FOR MANY SPECIMENS

BECAUSE SWABS PICK UP

EXTRANEOUS MICROBES, HOLD

EXTREMELY SMALL VOLUMES OF

THE SPECIMEN (0.05 ML),MAKE IT

DIFFICULT TO GET BACTERIA OR

FUNGI AWAY FROM THE SWAB

FIBERS AND ONTO MEDIA, AND

THE INOCULUM FROM THE SWAB

IS OFTEN NOT UNIFORM ACROSS

SEVERAL DIFFERENT AGAR

Dr.T.V.Rao MD 16

SWABS ARE ONLY IDEAL FROM

• SWABS ARE EXPECTED FROM

NASOPHARYNGEAL AND VIRAL

RESPIRATORY INFECTIONS. FLOCKED

SWABS HAVE BECOME A VALUABLE

TOOL FOR SPECIMEN COLLECTION AND

HAVE BEEN SHOWN TO BE MORE

EFFECTIVE THAN DACRON, RAYON,

AND COTTON SWABS IN MANY

SITUATIONS. THE FLOCKED NATURE OF

THE SWAB ALLOWS FOR MORE

EFFICIENT RELEASE OF CONTENTS

FOR EVALUATION.

Dr.T.V.Rao MD 17

IMPROVING THE QUALITY OF MICROBIOLOGY LABORATORY A

PRIORITY • MICROBIOLOGY LABORATORY

RESULTS THAT ARE REPORTED

SHOULD BE ACCURATE,

SIGNIFICANT, AND CLINICALLY

RELEVANT.

• SUSCEPTIBILITY TESTING

SHOULD BE PERFORMED ON

CLINICALLY SIGNIFICANT

ISOLATES, NOT ON ALL

MICROORGANISMS RECOVERED

IN CULTURE.

Dr.T.V.Rao MD 18

CREATE YOUR OWN TECHNICAL PROTOCOLS

• THE LABORATORY SHOULD BE

ALLOWED TO SET TECHNICAL

POLICY;

CREATE THE OPTIMAL AND

EFFECTIVE STANDARD OPERATIVE

PROCEDURES THIS IS NOT

THE PURVIEW OF THE MEDICAL

STAFF. GOOD COMMUNICATION

• AND MUTUAL RESPECT WILL LEAD

TO COLLABORATIVE POLICIES.

Dr.T.V.Rao MD 19

CREATE LABORATORY POLICY MANUAL WILL HELP THE COORDINATION WITH

CLINICAL STAFF • THE MICROBIOLOGY LABORATORY POLICY MANUAL SHOULD BE

AVAILABLE AT ALL TIMES FOR ALL MEDICAL STAFF TO REVIEW OR

CONSULT AND IT WOULD BE PARTICULARLY HELPFUL TO

ENCOURAGE THE NURSING STAFF TO REVIEW THE SPECIMEN

COLLECTION AND MANAGEMENT PORTION OF THE MANUAL. THIS

CAN FACILITATE COLLABORATION BETWEEN THE LABORATORY, WITH

THE MICROBIOLOGY EXPERTISE, AND THE SPECIMEN COLLECTION

PERSONNEL, WHO MAY KNOW VERY LITTLE ABOUT MICROBIOLOGY

OR WHAT THE LABORATORY NEEDS IN ORDER TO ESTABLISH OR

CONFIRM A DIAGNOSIS.Dr.T.V.Rao MD 20

WHERE WE STORE OUR SPECIMENS

• WHEN ROOM

TEMPERATURE (RT) IS

SPECIFIED FOR A

CERTAIN TIME PERIOD,

SUCH AS 2 HOURS, IT IS

EXPECTED THAT THE

SAMPLE SHOULD BE

REFRIGERATED AFTER

THAT TIME UNLESS

SPECIFIED OTHERWISE IN

Dr.T.V.Rao MD 21

WHERE WE STORE OUR SPECIMENS

• ALMOST ALL SPECIMENS FOR

VIRUS DETECTION SHOULD BE

TRANSPORTED ON WET ICE AND

FROZEN AT −80°C IF TESTING IS

DELAYED>48 HOURS, ALTHOUGH

SPECIMENS IN VIRAL TRANSPORT

MEDIA MAY BE TRANSPORTED AT

ROOM TEMPERATURE WHEN RAPID

(<2 HOURS) DELIVERY TO THE

LABORATORY IS ASSUREDDr.T.V.Rao MD 22

WISH TO LEARN MANY MATTERS ON CLINICAL SPECIMENS AND

PROCESSING • A GUIDE TO UTILIZATION OF THE MICROBIOLOGY

LABORATORY FOR DIAGNOSIS OF INFECTIOUS

DISEASES: 2013 RECOMMENDATIONS BY THE

INFECTIOUS DISEASES SOCIETY OF AMERICA

(IDSA) AND THE AMERICAN SOCIETY FOR

MICROBIOLOGY (ASM) AELLEN JO BARON, ET AL

Dr.T.V.Rao MD 23

VISIT ME FOR MORE ARTICLE OF INTEREST ON MICROBIOLOGY AND

INFECTIOUS DISEASES

Dr.T.V.Rao MD 24

• THE PROGRAM FILE IS CREATED BY

DR.T.V.RAO MD FROM I D S A G U I D E L I N

E S ON CLINICAL INFECTIOUS DISEASES

ADVANCE ACCESS PUBLISHED JULY 10,

2013

Dr.T.V.Rao MD 25